The Board of Directors of Dansk Luftambulance A/S - Falck

Facts about medical helicopters
• In November 2008, politicians in Denmark decided to implement nationwide medical
helicopters in Denmark in 2011 – as a supplement to the current force consisting of
ambulances and medical cars. The final location of helicopters and the final decision on
the operation of the helicopters has not been decided yet.
• Before the above-mentioned decision, the parliament in 2005 passed a law as part of
the structural reform with the intention of raising the quality of operations in the health
service department through efficiency improvement and better use of resources. Among
many initiatives, the focus was directed towards the two main areas: specialization and
immediate alert.
• As a consequence of this, a decrease in the number of immediate cases and a further
specialization in the remaining cases are expected. This requires more quality in the
pre-hospital effort – i.e. the effort being done before the hospital treatment.
• The National Board of Health has done some research on the topic of medical
helicopters and recommended, in an extensive report from 2007 on the future of
immediate alert situations, a nationwide solution involving four medical helicopters. This
means that a medical helicopter with a top speed of 270 kilometres per hour (like the
helicopter model EC135) will be able to reach any place of accident in the country
within 15 to 30 minutes.
• In the pre-hospital effort, the time factor from when an accident happens to the point
of time when he or she gets qualified medical treatment is essential.
• Quickly and efficiently, medical helicopters will be able to cover large geographical
areas with great distances to the relevant hospitals. This includes remote areas and
islands.
• On the basis of statistics, the National Board of Health contends that around 75 percent
of the daily helicopter operations will take place between 08:00 and 21:00.
• Statistics from the German air ambulance company DRF Luftrettung show that most
emergencies happen between 08:00 – 22:00 and that the busiest period primarily is
between 09:00 – 17:00.
• The Danish Civil Aviation Administration (CAA-DK) recommends the implementation of
daily operations in Denmark.
• A medical helicopter arrangement is a supplement to the current emergency operations
– ambulances and immediate medical cars.

About Falck, DRF Luftrettung and the cooperation with the Region of
Southern Denmark
• Danish Air Ambulances A/S is an existing medical helicopter arrangement that has been
used as an experimental scheme from April 2005 to July 2008 with support from EU
and in cooperation with what at the time was called the County of Southern Jutland
(this arrangement is ongoing with The Region of Southern Denmark), DRF Luftrettung,
Falck and Kreis Nordfriesland. Subsequently, the deal between the Region of Southern
Denmark and the other parties is transferred to a permanent part of the pre-hospital
effort in southern Jutland.
• In the spring of 2004, Falck Danmark A/S established the company Danish Air
Ambulances in cooperation with DRF Luftrettung. Falck supports the Niebüll Air Rescue
Center of the DRF Luftrettung by providing five HEMS-crew-members and medical
equipment.
• This agreement covers the northern part of Schleswig in Germany and southern Jutland
in the region of southern Denmark.
• DRF Luftrettung is an organisation operating on an non-profit basis that performs
helicopter services in Germany and Austria and it has more than 35 years of experience
in this area.
• DRF Luftrettung has 30 HEMS-bases (HEMS = Helicopter Emergency Medical Service)
with over 50 helicopters in Germany and Austria. Additionally, six aircrafts for
worldwide repatriation flights and a mission control center are operated under the
name of European Air Ambulance (EAA) in cooperation with Luxemburg Air Rescue.
• DRF Luftrettung flies emergency missions and intensive care transports and has
extensive experience with international repatriation missions.
• The personnel of the DRF Luftrettung consists of 500 doctors, 300 paramedics
(ambulance rescue officers with an HEMS education), 180 pilots and 70 technicians.
From September 2009 on, Falck has five specifically trained (HCM) paramedics who can
fly missions in Germany and Denmark.
• DRF Luftrettung performs more than 40,000 missions a year.
• Falck is the largest roadside and medical assistance company in the Nordic Countries,
the largest privately owned rescue company and world leading in rescue and safety
training in the offshore and maritime sector.
About helicopters on rescue duty
• A HEMS-helicopter, or rather medical helicopter, performs so-called immediate medical
operations.
• HEMS-operations can be a medical helicopter used for emergency missions or intensive
care transfers of patients between hospitals.
• The assignments of a medical helicopter may also include transports of medical
equipment, medical specialists or organs between hospitals.

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• After having established a diagnosis, it is the doctor who decides if the injured person
needs to be transported by helicopter or ambulance to a specific hospital (often the
final treatment place).
• Medical helicopters are used in cases of accidents, serious disease and urgent
transportations of intensive care patients.
• Medical helicopters are relatively small and make relatively little noise. They typically
weigh around three tons, are about 12 metres long and have a rotor diameter of
approximately 10 metres. This means that a medical helicopter can land in most places
close to expressways and other areas of emergencies even if the place is relatively
small. As a contrast to the small medical helicopter, the larger rescue helicopter weighs
15 tons with a much larger rotor diameter.
• Medical helicopters are well suited for smaller islands. The helicopter is a so-called
performance class 1 helicopter, which means it has an extra layer of safety – among
other things two powerful engines. When it operates more than ten minutes over water,
the helicopter is often equipped with so-called floats – floating devices strapped on to
the underframe of the helicopter.
• The rescue helicopter (SAR) Search And Rescue, is part of the relatively large type of
helicopters with construction, a rotor system, equipment and staff specifically suited for
operations over water and situations with a need for heat seeking camera, picking up
several people from ships, transport of heavy rescue equipment, winch missions and
the likes.
• Rescue helicopters are primarily used for searches, rescue operations over inland water
and rescue operations at sea. In Denmark, the air force’s helicopter squadron 722
performs this service.
• The National Board of Health estimates that the Defence’s current aid to the rescue
personnel, the civilian operations and transport between hospitals are rarely performed.
The Defence’s helicopter structure does not have the dimensions for solving these
assignments.
• The Defence commando does not see the rescue helicopters as a part of the prehospital
system as there are no resources for this, and for this reason the rescue
helicopters cannot be a permanent resource available to the National Board of Health.
• Medical helicopters are manned by a specially trained team consisting of a pilot, an
experienced medical specialist (often an anaesthesia medic) and an experienced
paramedic - a specially trained ambulance rescue officer who is able to assist the pilot
concerning navigation, radio relations and selection of landing spots, etc.
• The medical helicopter is equipped with advanced technical equipment optimally
adapted to the treatment of critically ill or injured patients - a practice well known from
fully equipped medical cars, for instance.
• The medical helicopter carries only one recumbent patient who is assisted by a doctor
and a paramedic right after the landing.

• The alarm call for medical helicopters will often occur after a call for 112. The decision
to call in medical helicopters is shared between the region of southern Denmark’s
operation control centre in Odense and the doctor on call in the southern part of
Jutland. Occasionally, the helicopter is called in on an inquiry from an ambulance. The
doctor in the helicopter will decide if the patient will only be treated on the spot or has
to be transported further in an ambulance or in the helicopter.
• Experience from Germany, England and Denmark shows that a maximum of two
minutes pass from the alarm call to a helicopter take off on primary missions.
• Medical helicopters are used among other places in countries like Sweden, Norway,
Finland, England, Germany, Holland, Belgium, Austria, Switzerland, Poland, the Czech
Republic and Italy.
About medical helicopter alert – day / night
• In principal, there are three models for HEMS-flying: 1) Day VFR means flying in
daylight according to official visual flight rules. 2) Night VFR means flying in the dark
according to official visual flight rules. 3) IFR means flying according to the official
instrument flight rules.
• The three HEMS-models have different demands for visibility, equipment in the
helicopter, landing areas and manning of the helicopter.
• Day-VFR flights are done at daytime if visibility suffices aviation regulations – from
about 30 minutes before sunrise to 30 minutes after sunset.
• Day-VFR flights requires one pilot who can fly and land both in unknown terrain and at
approved landing areas or hospitals with the necessary facilities.
• Night-VFR flights are done when visibility allows and considering cloud height – in the
period between half an hour after sunset and half an hour before sunrise.
• For night-VFR, two pilots are necessary – or one pilot and one HEMS-crew member who
has received training. Furthermore, IFR equipment in the helicopter is necessary. This
gives the pilot the opportunity to fly the helicopter according to the instruments alone.
• In principle, night-VFR enables flights 24 hours a day which means there is a 24 hour
alert because landings can be done at both approved and non-approved sites.
• IFR-flights are conducted when visibility is worse than by Day and Night-VFR. In this
case, the pilots will be flying the helicopter mainly by using the instruments. Regarding
IFR flights, only flights between two approved landing sites – or to an area with VFR
conditions - are allowed. The pilots need to be trained for IFR flights.
• IFR-flight also enables a 24 hour alert between two approved sites – for example flights
between two hospitals with the necessary equipment.

• In Denmark, there are around 50-60 public and private approved landing sites. An
approved landing site could include hospitals or trauma centres.The Danish Civil
Aviation Administration is responsible for approving the airfields and classifying them.
• The National Board of Health estimates that poor weather conditions will cancel only
around six percent of the Day-VFR-missions and only about 10 percent of the Night-
VFR-missions.
• Experience from England shows that at a mixed operation with both 12 hours and 24
hours alert performs at a 97,8 percent completion.
• Because of a higher risk when flying at night and landing at non-approved landing sites,
a group from the National Board of Health has suggested establishing a web of selected
landing sites in rough terrain (rendezvous spots) – for example a football field, a field, a
lawn or the likes. This approach has been used in other countries that employ their
medical helicopters at night.
• The helicopter will land at the rendezvous spot closest to the place of the accident. An
ambulance will drive the doctor to the place of the accident or the injured to the
medical helicopter that will continue to the relevant hospital.
• Experience from the Danish Air Ambulance’s flights in southern Jutland shows that the
helicopter in 95 percent of the cases will land within a 100 metres from the injured
person.
• In Norway, Sweden, Switzerland and Germany, Night Vision Goggles (NVG) are used
under certain circumstances. This equipment is strapped to the pilot’s face shield
enabling him or her to see in the dark.
• In Denmark, NVG equipment is considered military equipment. Flying with NVG
equipment requires a special permission from the Danish Civil Aviation Administration.
For further info and photos of the helicopter, please contact Danish Air Ambulance Director Leif
Joern Wiuff: +45 40 37 60 02
Sources:
Sundhedsstyrelsen, ”Styrket Akutberedskab – planlægningsgrundlag for det regionale
sundhedsvæsen”, 2007
Sundhedsstyrelsen, ”Landsdækkende lægehelikopterordning i Danmark – udredning”, Bilag 6,
2007
”Ambulanslogistik – prognostisering av ambulansuppdrag”, Erik Magnusson, 2007
”Medizinische Datenerfassung MEDAT”, DRF, 2006-2007
”Operational Status”, Bond, 2007
”I Luften om Natten”, Aalborg Universitet, Landinspektøruddannelsen, 2007.